Are My Crushing Headaches Actually Migraines?

Some lucky women go through life headache-free, while others suffer from frequent, raging throbs and are actively working with health-care professionals to tame them. Then there are those in-between — people who get headaches bad enough to make them Google “migraine” but not enough to seek medical advice.

If you’re in the latter group, you might occasionally bail on dinner plans when your head hurts, but you assume headaches are a fact of life. But how do you know when you should power through, and when you should look for outside help? “Headaches are such a common problem that people sometimes ignore them even though they can be associated with really severe disability,” says Teshamae Monteith, M.D., an assistant professor of clinical neurology and director of the headache program at the University of Miami Health System. Here’s what you should know.

Migraines consist of moderate to severe pain characterized by throbbing or pounding, usually on one side of the head (but sometimes on both). They’re often accompanied by sensitivity to light or sound, or even nausea or vomiting. Some people get warning signs like neck stiffness, thirst, or appetite changes. And there are secondary symptoms that can linger even after the pain is resolved, like fatigue, irritability, and a hung-over feeling, says Dr. Monteith, who’s also a member of the American Academy of Neurology. “For some patients, that can be more disabling than the actual migraine.”

As bad as this sounds, not everyone speaks up. Dr. Monteith says there’s a silent epidemic of underdiagnosed, undertreated migraines. “There’s one group of people that are missing work and there are the other people who are there, but in a sense they’re not there because they’re not functioning to the full capacity.” According to the 2010 Global Burden of Disease Study, migraine was the fourth-most disabling medical disorder among women, and the seventh overall.

Men do suffer from migraines, but they’re a more common problem in women — it’s estimated that the prevalence of migraines is 18 percent among women and 6 percent among men. Women usually experience their first one around the onset of their period and will continue to have them in their 20s, 30s, and even 40s. It’s thought that estrogen withdrawal can trigger migraines, and Dr. Monteith says some women experience more severe, longer-lasting headaches around their period (called menstrual migraines, which can be intermittent) or in the years approaching menopause.

You can try over-the-counter pain meds for an undiagnosed migraine, but if those don’t help, don’t keep suffering in silence — go see your primary-care doctor. “You don’t have to live like this,” Dr. Monteith says. “There are treatments, there’s a way forward. This is a modifiable condition.” Your doctor can talk with you about lifestyle factors that may be triggering headaches, including stress, poor sleep, skipping meals, and excessive caffeine use. He or she can also determine if you would benefit from taking daily, preventive medications or ones that can help “abort” a migraine when it happens, though many doctors suggest making behavioral changes first, Dr. Monteith says. The key is getting a diagnosis, then figuring out a plan that works for you.

For instance, preventive drugs like the anticonvulsant Topamax work for some migraine sufferers, but others report that they affect their mental clarity or even their mood. Dr. Monteith says some drugs do have side effects that can be “intolerable,” but it’s subjective: “Many patients actually say, ‘I will take my chances with side effects so that I can have my life back.’” You could try taking the drugs for six months to a year, see if you’re stable, and then discontinue them, but that approach might backfire.

Regardless of the situation, know that your options aren’t limited and you can and should discuss different solutions if you’re not satisfied. The American Academy of Neurology has reviewed studies on migraine-prevention treatments (including natural options like butterbur, feverfew, and vitamin B2), and created evidence-based guidelines based on their effectiveness and side effects.

If you find after seeing a general practitioner that the treatment doesn’t do much, or your symptoms change or worsen, you’re missing more work or social events, or your pain has sent you to the emergency room, then it’s time to contact a neurologist, Dr. Monteith says. For people with depression and anxiety, she says it’s best to see a neurologist first since those conditions can complicate treatment. And if you hit a plateau with a neurologist, there are headache specialists who may be able to help.

General practitioners and neurologists aren’t the only people who should know about your crippling headaches: Dr. Monteith suggests women who take or are considering taking birth-control pills tell their ob-gyn about any severe headaches with aura (that is, seeing zigzag lines or experiencing blind spots or tingling) because there is a small increased risk of stroke with oral contraceptives.

And a final word about safety, since this is, after all, a column called Am I Dying?: You’re probably not dying. That said, a severe headache can be a sign of a stroke — but it’s not the only warning sign. Others include sudden weakness on one side of the body, vertigo, speech problems, and vision loss. If you’re having some of these symptoms in the context of a migraine and you’ve never had them before, it’s wise to go to the ER just in case, Dr. Monteith says. While they’re typically benign in migraine sufferers, you’ll be able to talk to your doctor about what to do during future attacks.